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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607372
Report Date: 01/13/2023
Date Signed: 01/13/2023 11:20:36 AM


Document Has Been Signed on 01/13/2023 11:20 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:OAKVIEWFACILITY NUMBER:
197607372
ADMINISTRATOR:JEANNETTE RUGGIEROFACILITY TYPE:
740
ADDRESS:3557 CAMPUS DR.TELEPHONE:
(805) 241-2000
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:63CENSUS: 52DATE:
01/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jeannette RuggieroTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a required annual inspection. The LPA met with Jeannette Ruggiero and explained the reason for the visit.

The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

Kitchen: The menu was posted. The facility offers a standard menu and daily specials. The kitchen and dining room area was observed to be clean and in good condition. Resident Rooms: Rooms appeared to be well kempt and in good condition. During room inspection, the hot water measured at 123.4 degrees F. Restrooms: Restrooms were fully stocked with paper towels and soap. Hand washing signs were observed.

Common areas: The facility is a two-story building with resident rooms on both floors. There is a separate unit on the first floor is designated for dementia residents (The Gardens). Common areas included the dining rooms, library, activity rooms, beauty salon, and living rooms. All indoor and outdoor passages were clean and free of obstruction. Staff were observed wearing appropriate face coverings throughout the visit. In addition, the LPA observed hands-free hand sanitizer interspersed throughout the common grounds. Department required postings were found near the resident mailboxes.

There were no obstructions and/or tripping hazards throughout the facility. The facility maintains a comfortable temperature at 71 degrees. There are fire extinguishers throughout the facility, which were charged and last serviced 4/2022. Smoke Detectors and Carbon Monoxide detectors were tested within the past 12 months and were operable. The activity schedule was posted throughout the facility. Activity rooms and common spaces in both the Gardens and the Assisted Living areas appeared clean and in good repair.

Outside areas: There is a large outdoor patio with appropriate outdoor furniture for resident use. There was a water feature (waterfall) however, water rises at less than an inch and meets the level of the rocks.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OAKVIEW
FACILITY NUMBER: 197607372
VISIT DATE: 01/13/2023
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Infection Control: There was a central entry point for residents and guests to sign in. Infection Control signs were observed throughout the facility. Facility had a sufficient supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol was sufficient. The facility keeps record of staff and resident vaccinations. Staff are up to date regarding visitation protocol, screening recommendations for visitors and vaccine requirements. The facility can designate a single-person room to isolate persons if there is a confirmed case of COVID-19. The facility recently managed COVID-19 cases and complied with all requirements set forth by the local health department and licensing. The facility's procedures as it pertains to infection control were adequate.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit Interview Conducted. Appeal Rights Discussed. A Copy of the Report Issued.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/13/2023 11:20 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364


FACILITY NAME: OAKVIEW

FACILITY NUMBER: 197607372

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 01/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(2)
87303(e)(2) Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as the water temperature measured above 120 degree F in 1 out of 1 resident rooms, which poses an immediate health and safety risk to persons in care.
POC Due Date: 01/13/2023
Plan of Correction
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The Administrator agreed to do the following:
1. Staff will adjust the water tank by the end of the day.
2. Keep a water temperature for four (4) rooms (two upstairs, two downstairs) for three days. Submit the water temperature log no later than 1/20/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
LIC809 (FAS) - (06/04)
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